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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 376700693
Report Date: 10/26/2021
Date Signed: 10/26/2021 03:43:17 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/21/2021 and conducted by Evaluator Nasha King
PUBLIC
COMPLAINT CONTROL NUMBER: 10-CC-20211021143055
FACILITY NAME:BOYS & GIRLS CLUBS OF GREATER SAN DIEGOFACILITY NUMBER:
376700693
ADMINISTRATOR:OLGA CAMACHOFACILITY TYPE:
850
ADDRESS:115 W. WOODWARD AVETELEPHONE:
(760) 746-3315
CITY:ESCONDIDOSTATE: CAZIP CODE:
92025
CAPACITY:53CENSUS: 19DATE:
10/26/2021
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Jisela Flores, Assistant DirectorTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Staff yelled at child.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Nasha King and Andrea Taylor arrived at this facility and met with Jisela Flores, Assistant Director upon entrance of the facility. LPAs informed Ms. Flores the purpose of this visit, to conduct an investigation into the above allegation. LPAs toured the facility, conducted census, and interviewed staff and children. During the tour of the facility, LPAs met with Director, Olga Camacho, and informed Ms. Camacho the purpose of the visit.

It was alleged that staff yelled at child. During the investigation, LPAs reviewed facility records and conducted interviews with children and staff who are pertinent to this investigation. The above allegation was coorborated from the interviews conducted.

Based on LPAs interviews, the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations, 101223(a)(1), are being cited on the attached LIC 9099D.

See LIC 9099C for continuance of this report.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Carlos MartinezTELEPHONE: (951) 782-4950
LICENSING EVALUATOR NAME: Nasha KingTELEPHONE: (951) 204-2046
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 5
Control Number 10-CC-20211021143055
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: BOYS & GIRLS CLUBS OF GREATER SAN DIEGO
FACILITY NUMBER: 376700693
VISIT DATE: 10/26/2021
NARRATIVE
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An exit interview was conducted, and this report was reviewed with the licensee, Olga Camacho. Appeal rights were discussed and provided during the exit interview.

A notice of site visit was given and must remain posted for 30 days.
SUPERVISOR'S NAME: Carlos MartinezTELEPHONE: (951) 782-4950
LICENSING EVALUATOR NAME: Nasha KingTELEPHONE: (951) 204-2046
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2021
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 10-CC-20211021143055
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: BOYS & GIRLS CLUBS OF GREATER SAN DIEGO
FACILITY NUMBER: 376700693
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/26/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/26/2021
Section Cited
CCR
101223(a)(1)
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101223 Personal Rights (a) The licensee shall ensure that each child is accorded the following personal rights: (1) To be accorded dignity in his/her personal relationships with staff and other persons.

This requirement is not met as evidenced by:
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Ms. Camacho agreed to conduct a training with staff to talk about appropriate interactions with children. This training will be conducted by November 26, 2021. A copy of the agenda and sign-in sheet will be submitted to the department by the end of business day on November 26, 2021.
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Based on interview statements and records
review, staff yelled at child in care, which poses an immediate Health, Safety, or Personal Rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Carlos MartinezTELEPHONE: (951) 782-4950
LICENSING EVALUATOR NAME: Nasha KingTELEPHONE: (951) 204-2046
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2021
LIC9099 (FAS) - (06/04)
Page: 5 of 5